Family visit access in health and social care settings during the covid-19 outbreak

Aaron Kulakiewicz; David Foster; Philip Loft; Tom Powell

Health

Following the lifting of the national suspension of hospital visiting in England on 5 June 2020, family visits to inpatient settings is subject to local discretion by NHS trusts. The latest guidance from NHS England and NHS Improvement (NHSEI), Visiting healthcare inpatient settings during the COVID-19 pandemic (dated 13 October 2020), advises that visiting is allowed in inpatient settings, in a very careful and Covid-secure way. This guidance advises on how NHS and other healthcare organisations should facilitate visiting, as far as possible, across healthcare inpatient settings, including mental health, learning disability and autism, children, maternity and hospices. The guidance includes advice on the use of face coverings, social distancing, and virtual visits, as well as additional considerations for visiting at end of life. It also sets out circumstances where patients may be accompanied in hospital where appropriate and necessary to assist patients who need additional support (such as those with dementia).

It is important that any visitors follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing. Public Health England infection control guidance on reducing the risk of transmission of COVID-19 in the hospital setting provides some further general guidance on managing visitors to hospitals.

There is additional guidance from the NHS on reintroducing visitors within maternity services, which was issued on 8 September 2020: Framework to assist NHS trusts to reintroduce access for partners, visitors and other supporters of pregnant women in English maternity services. This builds on existing efforts throughout the pandemic to ensure partners were able to be present during labour while maintaining the safety of all patients, their families and healthcare staff. This guidance also applies to outpatient settings (such as antenatal appointments and scans). The Chief Midwifery Officer, Chief Allied Health Professions Officer (England), and the National Clinical Director for Maternity and Women’s Health wrote to all NHS Directors of Nursing and Heads of Midwifery in England on 19 September 2020 to remind them that the Framework guidance must be implemented so that women and able to be supported by partners at maternity units for appointments and births.

Social Care

Information concerning arrangements for visits to care homes by friends and family during the coronavirus outbreak is provided in section 2.5 of Library Briefing 9019, Coronavirus: Adult social care key issues and sources.

The briefing provides an overview of policy relating to care home visits from the start of the outbreak up to and including the national lockdown from 5 November. It also gives a brief outline of some of the concerns that have been raised regarding the restrictions placed on visiting care home residents during the pandemic.

UK Parliament Proceedings

Debates

Support for Children and Families: Covid-19

20 Oct 2020 | House of Commons | Westminster Hall | 682 cc301-328WH

Motion, That this House has considered support for children and families during the covid-19 outbreak. Agreed to on question.

Parliamentary Questions

Care Homes: Visits

20 Oct 2020 | HL8737

Asked by: The Lord Bishop of London

To ask Her Majesty’s Government what assessment they have made of the impact of visiting restrictions at care homes on the wellbeing of residents; and what plans they have to review their policy on visiting arrangement at care homes during the COVID-19 pandemic.

Answering Member: Lord Bethell | Department: Department of Health and Social Care

The Government is aware that limiting visits in care homes has been difficult for many families and residents who want to see their loved ones. Our priority is to prevent infections in care homes.

We recognise how important it is to allow care home residents to safely meet their loved ones, especially for those at the end of their lives. We appreciate the particular challenges visiting restrictions pose for people with dementia, people with learning disabilities and autistic adults, amongst others, as well as for their loved ones.

Care homes can now develop visiting policies based on a local dynamic risk assessment. This approach is based on the circumstances and needs of the individual care setting, including both residents and staff, and the external COVID-19 environment.

In the event of an outbreak in a care home and/or evidence of community hotspots or outbreaks, care homes may rapidly impose visiting restrictions to protect vulnerable individuals.

Care Homes: Coronavirus

20 Oct 2020 | 86105

Asked by: Rachael Maskell

To ask the Secretary of State for Health and Social Care, what assessment he has made of the risks to care home residents of the cessation of visits of (a) family and (b) health professionals during the covid-19 outbreak.

Answering Member: Helen Whately | Department: Department of Health and Social Care

We recognise how important it is to allow care home residents to safely meet their loved ones, especially for those at the end of their lives. We appreciate the particular challenges visiting restrictions pose for people with dementia, people with learning disabilities and autistic adults, amongst others, as well as for their loved ones.

Our first priority remains to prevent infections in care homes and protect staff and residents. On 18 September we published our Winter Plan which sets out tightened infection prevention and control measures to enable visits to continue safely. This guidance is available at the following link:

https://www.gov.uk/government/publications/adult-social-care-coronavirus-covid-19-winter-plan-2020-to-2021/adult-social-care-our-covid-19-winter-plan-2020-to-2021

At all times we have based our advice on the latest domestic and international evidence. We always seek to balance the impact that these measures may have, considering the physical and mental wellbeing of individuals alongside risks around transmission and the need to safeguard those living and working in care homes.

Maternity Services: Coronavirus

14 Oct 2020 | 98708

Asked by: Rebecca Long Bailey

To ask the Secretary of State for Health and Social Care, with reference to his Department’s guidance entitled Framework to assist NHS trusts to reintroduce access for partners, visitors and other supporters of pregnant women in English maternity services, published 8 September 2020, whether those NHS Trusts can apply for (a) funding or (b) other resources to support the reintroduction of familial access and maintain safety.

Answering Member: Ms Nadine Dorries | Department: Department of Health and Social Care

NHS England and NHS Improvement have made it clear that they expect all trusts to now use this Framework and consider how access can be safely reintroduced as a priority. Reintroducing visits is challenging during a pandemic, and the priority must remain the safety of all service users, staff and visitors.

The published Framework recommends a stepwise approach for trusts to take, following a meaningful and documented risk assessment, so any necessary changes can be made before relaxing current stringent approaches. Risk factors for trusts to consider include the local COVID-19 transmission rate and constraints with the hospital estate, which cannot be easily solved with funding. Additional advice has been made available through various networks to support trusts in applying the Framework to their local circumstances.

Care Homes: Visits

08 Oct 2020 | 85003

Asked by: Caroline Lucas

To ask the Secretary of State for Health and Social Care, what representations he has received on allocating key worker or equivalent status for family carers, enabling them access to (a) regular covid-19 testing, (b) PPE and (c) training on infection control so that they are able to visit their loved ones in care homes safely; what discussions he has had with (i) infection control experts and (ii) charities representing people living in care homes about those representations; and if he will make a statement.

Answering Member: Helen Whately | Department: Department of Health and Social Care

We continue to work closely and listen to the views and concerns of carer organisations and those they represent during this period.

Current clinical advice is that testing of individuals without symptoms, including family visitors of care home residents, should be used where clinically appropriate, predominantly for outbreak investigation and infection control. Our primary focus at present is testing all symptomatic people and asymptomatic people in specific circumstances, to ensure that everyone who needs a test can get one. That said, we have listened to unpaid carers’ concerns about getting access to testing and have made them a priority group for COVID-19 testing. They are now included in the list of essential workers that can get a COVID-19 test if they show symptoms.

We are not currently recommending that personal protective equipment be used by family carers unless it would ordinarily be used in delivering care to the individual, or if advised to do so by a healthcare professional. We are keeping this policy under review.

We have published guidance for unpaid carers on GOV.UK providing general advice, including advice on infection control, links to other information and support, and advice on caring where someone has symptoms.

Care Homes: Visits

29 Sep 2020 | 85944

Asked by: Sir Graham Brady

To ask the Secretary of State for Health and Social Care, if he will relax the rules on the number of family visitors for relatives in residential care on compassionate grounds in circumstances where residents are approaching end of life.

Answering Member: Helen Whately | Department: Department of Health and Social Care

We are aware that limiting visits in care homes has been difficult for many families and residents who want to see their loved ones. Our first priority is to prevent infections in care homes, and this means that visiting policy should still be restricted with alternatives sought wherever possible.

As set out in our guidance on visiting guidance for care homes, visiting policies will now be tailored to the individual care home, and will be based on a local dynamic risk-based approach. The guidance sets out how there may need to be different rules applied to different residents or categories of resident, taking into account tahe benefits to a person’s wellbeing by having a particular visitor or visitors. Specifically, the guidance confirms that any imposed visitor restrictions should have regard to exceptional circumstances such as end of life. The guidance is available at the following link:

https://www.gov.uk/government/publications/visiting-care-homes-during-coronavirus

This guidance will be updated as the risk posed by COVID-19 continues to change.

Coronavirus: Disease Control

28 Sep 2020 | HL8105

Asked by: Lord Alton of Liverpool

To ask Her Majesty’s Government what assessment they have made of the reasons why (1) the Scottish Government, and (2) the Welsh Government, have excluded children under the age of twelve from the rules which prevent groups of more than six gathering socially during the COVID-19 test; and what plans they have, if any, to exclude such children in England from those rules for (1) family visits,and (2) support from grandparents.

Answering Member: Lord Bethell | Department: Department of Health and Social Care

Health is a devolved matter and each administration has the discretion and flexibility to find the right balance between managing risks and relaxing measures.

The Government is keeping its social distancing measures under continual review. The Government will only make changes when we are confident, we can do so safely. The Secretary of State for Health and Social Care keeps the restrictions and requirements under constant consideration, to ensure the measures continue to be both proportionate and necessary

The new limit from 14 September does not prevent anyone from seeing their grandparents, but those who live in larger households will need to think carefully about how to organise their social interactions to remain within the law. We know this is difficult, but we know people will understand the need to take those steps which are necessary to keep their loved ones safe. These rules have been simplified and strengthened so they are easier to understand, and so the police can identify and disperse illegal gatherings. We are also acting now to get the virus under control and, if we achieve that, we may be able to make changes and potentially lift the restrictions.

Supported Housing: Visits

14 Sep 2020 | 84979

Asked by: Theresa Villiers

To ask the Secretary of State for Health and Social Care, what steps his Department is taking to facilitate visits to supported living facilities for disabled people in a covid-19-secure way.

Answering Member: Helen Whately | Department: Department of Health and Social Care

We appreciate the challenges which people in supported living and their families have faced as a result of lockdown.

Supported living managers should work with the people they support to follow Government guidelines for visiting in supported living arrangements and social distancing which are available at the following links:

https://www.gov.uk/government/publications/supported-living-services-during-coronavirus-covid-19/covid-19-guidance-for-supported-living

https://www.gov.uk/government/publications/staying-alert-and-safe-social-distancing

Providers should advise individuals about the safest way to have visitors.

As policy develops, we will continue to update the relevant guidance. Providers should continue to refer to existing guidance as the easement of lockdown continues.

Care Homes: Visits

03 Sep 2020 | 78525

Asked by: Sir Alan Campbell,

To ask the Secretary of State for Health and Social Care, if he will clarify guidance on the permitted social interactions for those in care home settings with their immediate family members.

Answering Member: Helen Whately | Department: Department of Health and Social Care

On 22 July 2020 the Government published updated guidance on visiting arrangements for care homes during the COVID-19 pandemic. This guidance is applicable to all nursing and care homes and is available at the following link:

https://www.gov.uk/government/publications/visiting-care-homes-during-coronavirus

We appreciate the challenges which care homes face in safeguarding their residents, and we are aware that limiting visits in care homes has been difficult for many families and residents. Care homes can now develop their visiting policies based on a local dynamic risk assessment. This approach is based on the circumstances and needs of the individual care setting, including both residents and staff and the external COVID-19 environment.

Statements

Adult Social Care Winter Plan

21 Sep 2020 | HCWS458

Helen Whately | Department of Health and Social Care

News and reports

News and Press Releases

The following includes a selection of news articles relevant to this debate. Please note that the Library is not responsible for either the views or the accuracy of external content.

DHSC: Visiting arrangements in care homes for the period of national restrictions – Alzheimer’s Society comments

Alzheimer’s Society

6 November 2020

Families revolt over coronavirus care home visit ban

The Times

Friday 6 November 2020

Covid: Care home visits advice impractical, say charities

BBC

5 November 2020

Family plead for change to care home rules after daughter’s arrest

The Guardian

5 Nov 2020